20020499.pdfDATE RECEIVED
[PERMIT EXPIRES
CITY OF EDMONDS
us PERMIT
.;(E C;��
NUMBER 'M
0
C CONSTRUCTION PERMIT APPLICATION
JOB E's SUITEIAPT#
ADDS
OWNER NAMEINZi OF BUSINESS
PLAT NAMEISUBDIVISION NO. I LOT NO,
L N
N
Al 'E
MAILIN.�VAI
Pj_ J,615 7
L�D
D EES
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP
'e— 4...
P.-A .
C .IT,
ITY ZIP
ITELEPHONE
EXISTING — PROPOSED —
REQUIRED DEDICATION— FT __
13
IN A. .dd 13
M
NA E
METER SIZE
'IN' SIZE
NO, 01 1IX1U111
PAY REQUIRED
I
I
YES 13 NO E3
A .. Else
REMARKS
OWNESICONTRACTOR RESPONSIBLE FOR EROSION CONTROUTHAINAGE
CITY 'ZIP
TELEPHONE
NAME 5--�4rZI-f 7 /f
AV
IN -Al- REVIEWED DATE
ADDRE a
PO, StX .3 / 51.
FIRE REVIEWED BY DATE
CITY ZIP
Segffle IM
TELEPHONE
cn�
STATE LICENSE NUMBER EXPIRATION
VARIANCEORCU
SHORELINE OR ADB#
I
INSPECTION
BOND
is POSTED
5A
A7777,01daq
OYEREISNO
-
Q PROPERTY TAX ACCOUNT PARCEL NO.
12
COMPLETE , X�IAPT
EXP
PRO
I ALLOWED POSED ALLOWED
SIR HT
IIIOP.�ED
NEW RESIDENTIAL 0 PLUMBING I MECH
19
LOT COVERAGE
ALLOWED PROPOSED
REQUIl ED SET ACKS (Fr.) PROPOS
� FRONT SIDE BEAR FRONT
SETBACKS ITT)
UR SIDE BEAR
C MPLIANCE OR
ADDITION 13 COMMERCIAL CHANGEOFUSE
REMODEL MULTIFAMILY SIGN
E:] REPAIR 0 ..A.ING cyos PENCE
I _X—FT)
A.
PARKING
REO'. I PROVIDED
LOT AT
I F
DATE
EMARKS
FE PRESENT FOR
DEMOLISH 2 TANK n OTHER
FIEL, HEMOVAL OR CAP
oGARAGE [3 RETAINING WALL 0 FIR SPRINKLER
CARPORT ROCKE!RY FIRE ALARM
A.
(TYPE O�USE, BUSINES ACT§
C 7,4AI
CHECKEQ!j!=N
OCCUPANT
R.up
NUMBER NUMBER .1 CRITIC L
A EAS
AA OF DWELLING A
STORIES UNITS NUMBER
SP..-INSPECTION IA..A
REQUIRED [I YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE p
4()4
T r_-'4r1'W en-T
REMARKS
PROGRESS INSPECTIONS PER USC 110111FINAL INSPECTION REO'D
5 aF e;4- W"If — .307 IaWl(a�
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE 11WING I LOT SLOPE
Building Permit
City Surcharge
PLAN CHECK NO:
lumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOT 0. THIS PERMIT COVERS WORK TO
t: "11114111 P11 PROPERTY 0"1 ANY CONSTRUCTION I" THE PUBLIC
Grading
LIOMAUJI (CURBS, SIDEWALKS, DRIVEWAY$, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PER TTAPPLICAXION: ISAIDAYS
A. PERMIT LIMIT I YEAR - PROno WORK IS STARTED WITHIN 16A)DAYS
ERIS, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO14
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORE
Fire Review
Plan Chk. Deposit
TO INDEMNIFY, DEFEND AND HOLD HARM EBB THE CITY OF
EDMONDS, WASHIN N� IT$ OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUA14CE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CHYS ABIL17Y TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
CALL
Thla application latun a pennit,nal signed by Are
1ION; AND IN DOING THE W RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
BoldiAir Offid.1 .1 Nether Deputy; And Fee, are paid. and
FOR INSPECTION ... lot ia A.kn—l.dg.d In Area. P—Wad.
WORKMENS COMPENSATIO GRAND AND RCW 18.27.
_"AURANC
OF 61 ATE
U11
14 �25
9-
A*AT
t2o
RELEASED 8
ATTENTION
Off 1333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR CANAL - FILE YELLON - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P= . OWNER GO D - ASSESSOR
4/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
z
0
C R1
rn 0 ,
0
80
C
ITT
z
o -n
n
m ITT
0
0
C
M 0
z
z
FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: ___YIREDEPARTMENT DATE
---- ENGINEERING DIVISION DATI�_
z
0
PLANNING DIVISION DATE-
0
PROJECT -7
3:
0
C
snEADDREss z6 14.1
M
0
0
PERMIT 700--)—ayl INSP ECTED_
M
_ADBk —DATE
M Z
DESC I RIPTION OF WORK TO BE INSPECTED 0 S9_ P VZn:e L, /- SC CAf
Cft
A field inspection was conducted to determine final compliance with approved plans. Final approval
0 -"
denotes that there are no objections from the above signed Department to the release of
n�
PERFORMANCE BONDS and the granting of:
M M
Vi
0
��4__GRANT FINAL PROJECT APPROVAL
0 M
C CD
9 (n I
M
Z 0
;a
GRANT PROJECT APPROVAL VMH CONDITIONS NOTED
z
a Copy of CONDITIONS given to owner/contractor by inspector
Cl)
z
d
0
M
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
a Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sigq_
ocaprvl.doc.l:tenq):bldg:fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing....................
Wall ...............
Pier/Porch
z
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground .............
a M
C
M
Rough -in ...................
0
Commercial Final
c:,
4 K
HEATING:
X rin
M z
ID
Gas Test ....................
Gas Piping
C
>
.................
Equipment ................. — - ------ -
0 _n
Commercial Final
M M
EXTERIOR SHEATHING
NAILING .. ......................
0
0
FRAMING .............
V)
M 0,
FIRST FLOOR FRAMING...
INSULATION ..............
Floor Insulation
z
Wall Insulation ...........
-4
Ceiling Insulation
z
SHEETROCK NAILING
01
0
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
-z/ �_,2=
OCCUPANCY ...............